My new article in Wound Management & Prevention is a critical re-examination of terminal ulcer terminology. In it I make the case for recognizing terminal ulcers as part of the spectrum of skin failure (and not necessarily heralding death) and used only in situations where patients are recognized as actively dying.
The article presents several reasons why terminal ulcer terminology should be used only in limited fashion. These include the conflation of diagnosis and prognosis which are separate concepts, inaccuracy of prediction of death, advances in healthcare technology, variation in end-of-life trajectories, and introduction of defensive verbiage that relies on the impending death to relieve caregivers of responsibility for potential quality deficit.
Finally I argue that terminal ulceration needs to be recognized as part of the spectrum of skin failure, drawing on physiology to explain both acute breakdown and impaired wound healing in many patients.
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